Melissa Seligman started shaking when her husband described the aftermath of a suicide bombing he witnessed during his first deployment to Iraq.
She had heard that same flat, detached tone, from her father, when he described seeing a helicopter gunner's leg get blown off in Vietnam.
"There's something so horrible about somebody being so traumatized ... there's no emotion attached," Seligman says. "My dad would talk like that. My entire insides would shake until I didn't know what to do."
She eventually realized that the post-traumatic stress that had haunted her father now dogged her husband.
Hundreds of thousands of military families face similar dilemmas as combat troops suffering from PTS come home, attempt to get jobs, reintegrate into society, mend fractured personal relationships and get help from VA's overwhelmed mental health care system. It's a dilemma that reopens invisible wounds for Vietnam veterans who don't want today's generation to endure the same mistreatment they faced when they came home from war. It's also a cautionary tale for a nation too often insulated from the mental-health consequences of wartime military service. The Vietnam experience demonstrates that the price of not treating PTS is paid in suicide, substance abuse, homelessness, unemployment, divorce and domestic violence.
"We're sending our people over there with a very high risk they will come back with psychological problems, and we're not prepared," says Susan Selke, whose son, Marine Corps veteran Clay Hunt, committed suicide after battling PTS and survivor's guilt.
"Substantial unmet need for care."
Some 300,000 Iraq and Afghanistan veterans – nearly 20 percent of returning troops – are coming home with PTS or depression, according a 2008 study by the RAND Corporation, a nonprofit research group. Roughly half have sought treatment from VA. There is "substantial unmet need for care," RAND reports.
This spring, a federal appeals court declared VA's mental-health care system broken, and ordered a lower court to find a way to end delays in care delivery that may be costing veterans their lives. Nearly 86,000 veterans were languishing on VA waiting lists for mental-health care as of April 2008, "a number that may significantly under-represent the scale of the problem both then and now," the 9th U.S. Circuit Court of Appeals said. The court blamed gross inefficiency, not a lack of funding, for VA problems that leave veterans "suffering and dying, heedlessly and needlessly."
Statistics, however, only capture a snapshot in time, says Dr. Julie C. Chapman, director of neuroscience at VA's War Related Illness and Injury Study Center in Washington. It may be years, or even decades, before the mental-health toll of the current wars is known. "Symptoms can submerge and then re-emerge many years later, sometimes during stress or life change."
"Knowing what war is all about ... it was hard for me to see him go through that."
The Vietnam nightmares grew steadily worse for Melissa Seligman's father after his son-in-law, David, began deploying to Afghanistan and Iraq in 2003. "Knowing what war is all about, it was hard for me to see him go through that," says Paul Sutton. "You live with it for the rest of your life."
Sutton joined the Air Force on his 17th birthday, and went to Southeast Asia 18 months later. He served four months rescuing downed U.S. pilots, and another year with a unit that provided air-to-ground radio support for allied forces. Coming home in 1966 was worse than he imagined. He says the civilian world either hated him, didn't understand him, or both.
"There was no support and no appreciation at all for serving my country," Sutton says. "I did not want to be around anyone. It is still hard for me to be around people."
He returned home to Kentucky, where he raised his daughter in the outdoors – canoeing, flying and rappelling. She learned to sit quietly with him for hours, seeing things in her father she did not understand. "I knew the war had impacted him," she says. "But I didn't have any words to describe it."
She remembers how his jaw would clench and he would go silent whenever he saw a photo of a buddy from Vietnam. She remembers his startled reactions whenever she touched him.
She remembers telling the story of a little Vietnamese girl who visited his camp. He gave the girl candy and invited her back. She returned with a grenade, pulled the pin, and blew herself up. A few years ago, Seligman's father told her the rest of the story, the part that most torments him.
"He sat there and cried and said, ‘I did that to her.'"
"I was getting eaten alive by things I didn't understand."
When U.S. troops returned from Vietnam, America largely failed to welcome them home and could not grasp the magnitude of their mental wounds. Ken Jones felt no connection to life in the States when he came home in 1968 after a year as a scout-squad leader with the 11th Cavalry. He wanted to return to Vietnam, where he understood his place. "You come to the question of core identity," Jones says.
"There's a cultural displacement when you come back and realize, in a very short time, the place you thought of as home no longer exists."
Eight months later, Jones started suffering severe anxiety. His blood pressure skyrocketed. "I was getting eaten alive by things I didn't understand," Jones says. The trip-wire anger he unintentionally brought home from Vietnam had one benefit: it triggered adrenaline rushes that vanquished his bouts of depression.
Jones threw himself into his work as a financial adviser and pension-management consultant. He went running at night to exhaust his demons. In the late 1970s, he started writing about his nightmares, which became the basis for his book "When Our Troops Come Home."
Thom Paca unraveled before he left the war zone. Nine months into his tour as an infantry-weapons squad leader, he "whipped a fellow pretty good with a machine gun," told off his lieutenant and fled into the jungle. Paca's buddies tracked him down and persuaded him to return. His commander decided he had battle fatigue, and shipped him to Japan for a psychiatric evaluation.
"I was found ‘physically fit but not responsible for my actions,'" Paca says. That was all the mental-health treatment he received. He returned to Vietnam and spent the last three months of his deployment confined to camp without a weapon. He finished his Army hitch stateside, and left the minute his discharge papers were signed, declining to stay even one extra day for a medical evaluation.
Thirty years, two failed marriages and a string of jobs later, Paca was diagnosed with PTS after a fellow Vietnam War veteran encouraged him to get help. Today anxiety, mood swings and stress are straining his third marriage. "I tell him we have a 50-50 chance," Paca's wife, Sharon, says. "But we're still trying."
Such stories are familiar to retired nurse Arlene Lynch, who worked with Vietnam War veterans in the Seattle VA Medical Center psychiatric ward in the late 1990s.
"These were kids who should have been driving around in cars looking at girls" instead of going into combat, Lynch says. "They didn't know what to do with the rage and the anger. It's no surprise they melted down."
Coming home to a nation that didn't want to hear about the war exacerbated the trauma.
"They learned to keep their heads down and their mouths shut," Lynch says. "But they couldn't keep all that stuff inside. It manifests itself in suicide, drinking, drug abuse, murders, not being able to do jobs or keep relationships. It was common knowledge among the guys on the psych unit at the VA that twice as many Vietnam vets died from suicide as died in battle."
Indeed, Jones thought he was going to kill himself or go crazy when he finally went to a VA vet center in Anchorage in 1980. He showed some of his Vietnam writings to a counselor, who read six pages and told him, "You've come to the right place. We speak this lingo." Even then, it would take years of work for Jones to get a handle on his stress, depression and anxiety.
"We said, ‘We don't know what we are, but we aren't that.'"
The medical community had trouble understanding what Vietnam veterans were going through, even though references to combat trauma and survivor's guilt date back to Homer's account of the Trojan Wars. They met with everything from skepticism to misdiagnosis to ridicule.
"One of the most important contributions of Vietnam veterans was they refused to accept the diagnosis of paranoid schizophrenia from VA or civilian doctors," Jones said. "We said, ‘We don't know what we are, but we aren't that.'"
Similar symptoms may have caused confusion, Chapman says. "One of the potential diagnostic criteria for schizophrenia are hallucinations. A soldier's description of flashbacks might have led a clinician to consider hallucinations, associated with schizophrenia. Similarly, when an individual is exhibiting strong hypervigilance, it might look like paranoia – particularly before PTSD was well-understood."
The experience of Vietnam veterans brought post-traumatic stress to the attention of the medical community and the nation. "Although combat exposure increases the risk of PTSD in any conflict, a greater number of veterans of the Vietnam War experienced PTSD than have been identified in other conflicts," Chapman says. "Awareness was raised, and attention was focused."
The American Psychological Association recognized post-traumatic stress disorder as a distinct diagnosis in 1980. Three years later, Congress mandated a government study on the prevalence of the condition. The National Vietnam Veterans Readjustment Study found that 15 percent of the war's male veterans had PTS, compared with 5 percent of the civilian population.
Fourteen years later, 1,400 Vietnam combat veterans who belonged to The American Legion participated in a follow-up study that showed that PTS had dropped only slightly over that time. "It was important to characterize the lifetime course of this condition – whether it would resolve, remain, or reappear periodically, to what degree, and in what form," Chapman says.
The Legion follow-up study also found that Vietnam veterans with PTS experienced higher rates of divorce, cardiovascular disease, fatigue and compromised immune systems. "The distinction between physical health and mental health is artificial," Chapman says.
While society and the medical community were coming to terms with PTS, small groups of Vietnam veterans began to meet in informal gathering spots, such as the empty room above the Flower and Dragon restaurant in San Francisco. At first, no one spoke. "They didn't have a word for what they were experiencing," Jones says. "They drew strength from each other. At least they knew they weren't alone."
That informal effort gave rise to the storefront Vet Centers – later adopted by VA – that would help Paca, Jones and many other Vietnam veterans manage the trauma that followed them home from war. "The tag line," Jones says, "was ‘Help without Hassles.'"
"You are freaked out until the next thing happens that freaks you out more."
Thirty years later, Oregon Army National Guard veteran Jeff McDowell turned to the Vet Center in Eugene, Ore., for help dealing with his brutal combat tour in Baghdad. His counselor, the son of a Vietnam veteran with severe PTS, quickly concluded that McDowell also had the condition.
McDowell's scout platoon conducted approximately 270 missions during its year in downtown Baghdad. That included investigating IED blasts and providing security for government ministries and hotels, as well as occasional forays into Baghdad neighborhoods. "We'd go to check something out, hear a big boom, and just keep going, mission to mission," says McDowell, who served as platoon sergeant during a 2004-2005 deployment.
Enemy identification was mind-bending for U.S. troops who patrolled Iraq, as it was for those who fought in Vietnam. Insurgents and civilians dressed alike. The rules of engagement changed rapidly. "You are freaked out until the next thing happens that freaks you out more," McDowell says. "Three-hundred and sixty-five days of that, and you fly back home."
Like Vietnam veterans, soldiers returning from Iraq and Afghanistan often feel out of place when they try to return to civilian life, so they return to the military and re-enter the war. Job-hunting is arduous. Relationships can be impossible.
"We did an unofficial poll of 300 or 400 soldiers who went over with us," McDowell says. "We had an 86-percent divorce rate. I can count on two hands the number who don't have at least one divorce. Some had two, some three."
McDowell was 40 when he came home from his deployment. The transition was difficult. His contracting business had withered. He was short-fused with his wife and children. He no longer cared about hunting and fishing, which he had loved before his deployment. "I lost my joy," McDowell says. His wife encouraged him to get help, and he's parlayed that into a career helping others.
After retiring from the National Guard in 2007, McDowell entered a master's program in counseling to assist other veterans. "I started seeing some of my guys fall apart," he says. "I felt responsible for them. I thought, if I can figure some of this stuff out for myself, maybe I can figure it out for the other guys."
He's already seeing veterans as part of an unpaid internship with a private, nonprofit counseling group. He hopes to put his skills to work at the Eugene VA Vet Center.
McDowell made careful choices. He got counseling. He participated in a neuro-feedback treatment program. He also decided to never carry a weapon of any kind, knowing that he couldn't shut off his combat instincts.
"You start thinking about the things you did, the way you reacted, the training you got, and you know you are not the same person," McDowell says. "I spent a lot of time thinking about this ... about whether I was going to like this (new) person."
"To an extent, I need David to stay trigger-ready."
Families struggle with their own stresses caring for loved ones with PTS. "A lot of times, spouses become the sponges," Melissa Seligman says, "and have nowhere to release it." They often face their own secondary PTS.
Seligman started convulsing when her husband described the carnage from that suicide bombing in the same flat, emotionless tone her father used to tell his story about the helicopter gunner losing a leg in Vietnam. David had the same startled reaction as her dad when Selignam touched him. And he exploded with anger for no apparent reason. It would be three years, including another combat deployment and a year at Officer Candidate School, before they could confront his PTS.
Like most military spouses, Seligman was reluctant to seek help for herself, worried that she would be taking resources from people in greater need. Then she came across Ken Jones on Twitter, and started talking to him about her experiences with her husband and her father. Not only was Jones a Vietnam combat veteran, but he had grown up in the shadow of his own father's World War II post-traumatic stress.
"For the first time, I had a translator," she says. "Ken Jones opened up the world for understanding both men."
Understanding David's triggers helps her to realize that his reactions aren't personal, to negotiate the difficult moments, and to foster his relationship with their children.
Soon, Seligman and Chris Piper – who together co-founded the "Her War, Her Voice" blog – were recording their conversations about combat stress and military families with Jones and posting them on the Internet. David Seligman decided to seek counseling after hearing just one of those conversations.
Even this victory comes with caution, a question about whether too much healing will dull the edge that keeps her husband alive. "To an extent, I need David to stay trigger-ready," Seligman says. "I need him to be numb to the horrors of war. Because without that numbness, he may make mistakes."
Inspired by his son-in-law and encouraged by his VA doctor, her father started getting help for his PTS a year ago. Seligman is relieved that the most important men in her life are healing; she no longer shakes when they talk about the events they witnessed. Still, she wishes she had the power to reach into the past and find a way to end her father's nightmares.
"I always wanted him to be better," Seligman says. "As a wife and mother, it makes me wonder how I could have changed things if I had just asked him. I wonder who he would have been if someone had listened."
Ken Olsen is a frequent contributor to The American Legion Magazine.